Catastrophic femoral head trunnion dissociation: a case series with surface wear analysis

Wood, Thomas J.; Alzahrani, Mohammad M.; Langohr, Daniel G.; Teeter, Matthew G.; Howard, James L.; Schemitsch, Emil H.; Lanting, Brent A.

doi:10.1177/1120700019860774

Cited by 9 publications

(7 citation statements)

References 11 publications

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“…Surface wear analyses of retrieved trunnions have demonstrated asymmetric material loss, supporting the idea of an abrasive wear pattern that is dependent on the direction of the moment around the centre of the taper. 16,24 Overall, these findings suggest that this implant's gross trunnion failure represents an end-stage of MACC. 24 Further, while gross trunnion failure of the femoral component of interest has been noted, additional reports have documented the implant's success.…”

Section: Introductionmentioning

confidence: 79%

“…After institutional ethics approval, our implant retrieval laboratory database was reviewed for all recovered cementless Accolade I titanium-molybdenum-zirconium-iron (Ti-12Mo-6Zr-2Fe, TMZF, Stryker Orthopaedics, Mahwah, NJ, USA) femoral prostheses from 2005 to 2020 as this stem has been noted to have an increased propensity for gross trunnion failure. 16,18,21,22 Exclusion criteria included the Accolade II stem design as well as any cementless Accolade I TMZF stems that had been retrieved in the setting of gross trunnion failure. This yielded 24 stems retrieved from 24 patients for study inclusion.…”

Section: Methodsmentioning

confidence: 99%

“…4,14,15 Prior studies have identified a femoral component design from a single manufacturer with an increased propensity for gross trunnion failure (Figure 1). [16][17][18][19][20][21][22][23][24] These events involve either fracture of the trunnion or dissociation of femoral head from the trunnion (Table 1). Several explanations for gross trunnion failure of this implant have been put forth.…”

Section: Introductionmentioning

confidence: 99%

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Quantification of trunnion damage in a series of intact total hip arthroplasty femoral stems previously identified to be at risk of catastrophic failure

Lanting,

Sogbein,

MacDonald

et al. 2023

HIP International

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Background: Corrosion at the head-neck junction of femoral stems is a rare complication of total hip arthroplasty (THA) with manifestations ranging from subclinical wear to failure. Prior studies have identified a single femoral component design with an increased propensity for catastrophic trunnion failure. The purpose of the present study was to quantify trunnion damage of this femoral component retrieved from patients undergoing revision THA for non-trunnionosis indications. Methods: 24 femoral components from a single manufacturer were identified for study inclusion. Each prosthesis underwent stereomicroscopic inspection. Corrosion and fretting scores were assigned per the Goldberg criteria to quadrants of the trunnion. Material loss was calculated based on cone angles across trunnion quadrants. This was carried out using a coordinate measuring machine that digitised each trunnion surface. Stems were compared to a series of femoral stems with the same trunnion design. Results: 20 of the 24 (83%) trunnions demonstrated corrosion, all 24 trunnions demonstrated fretting. Corrosion scores did not statistically differ with respect to trunnion zone ( p = 0.53), while fretting scores were higher in the inferior compared to the superior zones ( p < 0.001). There was no significant difference in cone angles assessing material loss between stems ( p = 0.25). Conclusions: Evidence of trunnion damage was observed in each stem retrieved for non-trunnionosis revision. Fretting occurred more frequently about the inferior quadrants. However, digitised trunnion shapes were similar between compared stems exhibiting no material loss. Therefore, it is possible that previous reports of trunnion failures for this implant are not a systemic issue, and that further investigation is required.

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Section: Introductionmentioning

confidence: 79%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quantification of trunnion damage in a series of intact total hip arthroplasty femoral stems previously identified to be at risk of catastrophic failure

Lanting,

Sogbein,

MacDonald

et al. 2023

HIP International

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“…Of these, 24 cases had no radiographic findings of trunnionosis [ 17 , [24] , [25] , [26] , [27] , [28] ]. Almost two-third of the cases had complete dissociation, gross trunnion failure, or femoral neck fracture evident on a radiograph [ 17 , 25 , 26 , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] ]. Figure 4 represents this more common radiographic presentation of gross trunnion failure seen at the same medical center as the patient in our case report.…”

Section: Discussionmentioning

confidence: 99%

Impending Trunnion Failure: An Uncommon Radiographic Presentation of Total Hip Arthroplasty Failure

et al. 2021

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Trunnionosis is emerging as an early mode of failure in conventional metal-on-polyethylene total hip arthroplasty. It is defined as wear or corrosion at the trunnion, the taper at the femoral head-neck interface. Trunnion wear can result in a variety of negative sequelae and, in severe cases, necessitate revision arthroplasty. We describe a 64-year-old man with a metal-on-polyethylene total hip arthroplasty who presented with a sensation of clunking in the hip. Initial imaging and laboratory studies were inconclusive, and the decision was made to monitor. Two years later, trunnion wear was detected on radiographs, presenting as an abnormal alignment of the femoral neck relative to the femoral head. Several case reports and series describe catastrophic total hip arthroplasty failure due to trunnionosis. However, few describe the radiographic signs of wear at the trunnion before gross failure. This early presentation is important to recognize to minimize patient morbidity and aid surgical planning.

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“…These failures have occurred when this stem has been used in combination with the LFIT V40 cobalt-chromium (CoCr) head (Stryker). The failures described in the literature have been in the form of corrosion and metallosis leading to trunnionosis and at times catastrophic trunnion fracture 11 . Concerns also have been raised about early migration and aseptic loosening of this particular stem 12 .…”

mentioning

confidence: 99%

Intermediate to Long-Term Outcomes and Causes of Aseptic Failure of an At-Risk Femoral Stem

Gazendam

Ekhtiari

Wood

2022

Journal of Bone and Joint Surgery

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Background: The Accolade TMZF is a tapered-wedge cementless metaphyseal-coated femoral stem that was widely utilized from 2002 to 2012. In recent years, there have been reports of early catastrophic failure of this implant. The purposes of the present study were to establish the long-term survival of this stem and to analyze patients who underwent aseptic revision to understand the causes and risk factors for failure.Methods: We retrospectively reviewed the records of all patients who had undergone primary total hip arthroplasty with use of an Accolade TMZF stem at a high-volume arthroplasty center. The causes and timing of revision surgery were documented. Survivorship analysis was performed with use of Kaplan-Meier curves to determine the overall and aseptic survival rates at the time of the latest follow-up. Patient and implant factors commonly associated with aseptic failure were extracted, and a Cox proportional hazards model was used.Results: A consecutive series of 2,609 patients who had undergone unilateral primary total hip arthroplasty with use of an Accolade TMZF femoral stem were included. The mean time from the primary procedure was 11.3 years (range, 0 days to 19.4 years). The cumulative survival rate was 95.5% ± 0.1% at the time of the latest follow-up. One hundred and seven patients underwent revision surgery, with aseptic loosening of the femoral component being the most common cause of aseptic failure in this cohort (33 of 2,609; 1.3%). Smaller femoral size and larger femoral head offset were independent risk factors for aseptic failure.Conclusions: To our knowledge, this is the largest series representing the longest follow-up of this tapered-wedge cementless femoral implant. Despite early concerns, the Accolade TMZF stem had excellent survivorship in this cohort. Trunnionosis as the cause for revision surgery was rare.

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Catastrophic femoral head trunnion dissociation: a case series with surface wear analysis

Cited by 9 publications

References 11 publications

Quantification of trunnion damage in a series of intact total hip arthroplasty femoral stems previously identified to be at risk of catastrophic failure

Quantification of trunnion damage in a series of intact total hip arthroplasty femoral stems previously identified to be at risk of catastrophic failure

Impending Trunnion Failure: An Uncommon Radiographic Presentation of Total Hip Arthroplasty Failure

Intermediate to Long-Term Outcomes and Causes of Aseptic Failure of an At-Risk Femoral Stem

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